Course Category

Print-friendly format:

Extraordinary efforts have been made by the authors, the editor and the publisher of the National Center of Continuing Education, Inc. courses to ensure dosage recommendations and treatments are precise and agree with the highest standards of practice. However, as a result of accumulating clinical experience and continuing laboratory studies, dosage schedules and/or treatment recommendations are often altered or discontinued. In all cases the advice of a physician should be sought and followed concerning initiating or discontinuing all medications or treatments. The planner(s), author(s) and/or editor(s) of each course have attested to no conflict of interest nor bias on the subject. The National Center of Continuing Education, Inc. does not accept commercial support on any course nor do they endorse any products that may be mentioned in the course. Any off-label use for medications mentioned in a course is identified as such.

No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior written permission of the publisher.

Course #626

ContactHours

1

$16.95

Course Material Valid ThroughSeptember 2020

Ebola and Zika Viruses

Author: James R. Wittenauer II, RN, MSN, MPA, RN-BC

In this CE offering we will look at the Ebola virus disease in light of
what kind of virus it is and how it is spread. We will also look at how
it is treated and what health professionals can do to protect not only
yourself and your patients, but also your loved ones. We will also take
a look at prevention of the disease as well as the new experimental
vaccine that has started its trials, and will briefly look at the newest
threat of the Zika virus; a virus that could rival that of Ebola in its’
severity of long-term morbidity.

About the Author

James R. Wittenauer II, RN, MSN, MPA, RN-BC is a retired Air Force Officer with a Bachelor's Degree in nursing from Lewis Clark State College and a Master’s Degree in Public Administration from Troy State University.Mr. Wittenauer is a clinical nurse in an intensive care unit in a hospital in Ohio where he has been for 10 years as well as a clinical instructor for Breckinridge School of Nursing. Mr. Wittenauer has written previous courses for the National Center for Continuing Education. Mr. Wittenauer is a board certified Pain Management Nurse and a peer reviewer for Federal Practitioner Journal which is a national journal for the Department of Defense/VA health care providers.

Instructional Objectives

By the end of this course the reader will be able to:

Define Ebola virus with respect to what kind of virus it is.

Delineate the predominance of the Ebola virus with regard to
epidemiology.

Demonstrate the best way for health professionals to protect
themselves, their other patients and loved ones.

Outline treatments that are available for the Ebola virus; both
traditional and experimental treatments.

Briefly describe the Zika virus in terms of causation, signs and
symptoms.

Outline the strategies for prevention of the Zika virus in the
United States as well as the current treatments.

Introduction

In the recent years of 2014 and 2015 there has been much debate,
speculation and argument regarding the Ebola virus. What isn’t any
debate is that nursing is at the forefront of this disease. The media
has had various nurses and doctors in the spotlight with regard to the
contraction of the disease, the quarantine of the nurses, as well as the
supportive and new experimental treatment given to some of the patients.
In this CE offering we will look at the Ebola virus disease in light of
what kind of virus it is and how it is spread. We will also look at how
it is treated and what health professionals can do to protect not only
yourself and your patients, but also your loved ones. We will also take
a look at prevention of the disease as well as the new experimental
vaccine that has started its trials, and will briefly look at the newest
threat of the Zika virus; a virus that could rival that of Ebola in its’
severity of long-term morbidity.

Virus Characteristics

The Ebola virus belongs to a class of viruses called Filo viruses that
cause a hemorrhagic fever. Another of this kind of viruses is called
Marburg virus. The Ebola virus measures 970nm and is characterized by
long convoluted strands. The virus was first recognized in 1976 when
epidemics of the disease broke out in the African countries of Zaire and
Sudan. The mortality of these epidemics was 88% and 53% respectively and
it is believed that the epidemic in Zaire was caused by the improper
sterilization of needles.

There are different subtypes of the Ebola virus with each subtype given
the name as to where they were first discovered. They are the subtypes
of Ebola Zaire, Ebola Sudan, Ebola Bundibugyo, Ebola Tai Forest formerly
known as Ebola Côte D’Ivorie, and Ebola Reston which was isolated in
Reston, Virginia in the United States. The Reston subtype although
dangerous to non-human primates has not been proven to affect human
beings. Each of these subtypes produce a differing level of morbidity
and mortality with the Sudan subtype at 50% and the Zaire subtype at
80-90%; needless to say the Zaire subtype of the virus is the most
deadly form of the disease.

The Ebola virus is prevalent in the world today as of early 2016 in the
African countries of Guinea, Liberia, and Sierra Leone with case number
of 28,616 cases resulting in more than 11,310 deaths. Reported travel
associated cases have been reported from Mali, Senegal with 2 cases and
2 deaths, and the countries with limited transmissions have been the
United States, Spain and Nigeria with 25 cases and 10 deaths.

The virus is spread to humans by way of an infected animal such as
primate or bat with the main reservoir being the fruit bat. When this
happens it is called a spillover event. After a human becomes infected,
transmission by way of human to human results from direct contact
exposure from someone who has an active infection or exposure to that
persons’ blood or body fluids (e.g. sweat, feces, semen, and breast
milk). Exposure can also occur from contaminated needles as well.

Diagnosis

Diagnosis of the Ebola disease is verified by a variety of tests. The
type of test performed is dependent on the timeline of the infection.
The tests performed within a few days of clinical symptoms that appear
include: Antigen-capture enzyme-linked immunosorbent assay (ELISA) test,
the IgM ElISA, polymerase chain reaction and virus isolation test. The
assays used later in the disease course include the IgM and IgG antibody
tests. There are also tests to discover the presence of the disease
postmortem including the virus isolation, polymerase chain reaction
(PCR) test and immunohistochemistry testing. Ebola virus is detected in
blood only after onset of symptoms, most notably fever, which accompany
the rise in circulating virus within the patient's body. It may take up
to three days after symptoms start for the virus to reach detectable
levels.

Clinical Manifestations and Disease Progression

The Ebola virus clinically manifests on average from 8-10 days with
symptoms that present without any warning at all. The initial symptoms
are: fever, myalgia, headache, nausea and vomiting, abdominal pain,
diarrhea, chest pain, cough and pharyngitis. Other symptoms include
photophobia, lymphadenopathy, jaundice and pancreatitis. There is also a
central nervous system involvement marked by somnolence, the patient can
become delirious and slip into a coma. Progression of the disease is
marked by tissue wasting, bruising, petechial and mucous membrane
hemorrhage and rash around the body trunk occur about the 5th day of the
first week. Within the second week the patient either improves; or dies
as a result multi-organ system failure (MSOF). The patients that do
improve and survive usually have antibodies that are present with them
for 10 years at least.

Prevention

Prevention of the Ebola disease is primarily based on doing things
that nurses already know to do, but must pay special and careful
attention to do these things well. These preventative measures are:

Ensuring that any person suspected of having Ebola or who presents
with the signs/symptoms of Ebola is properly isolated; and

Avoiding direct contact with patients that have died from Ebola.

Source: CDC, 2014

Treatment of the Ebola Disease

Treatment of the Ebola disease process is mainly aimed at supportive
care. The supportive measures include Intravenous fluids, oxygen and
medications to maintain adequate blood pressure for end organ perfusion
as well as treatment of secondary infections should they arise.

Even after recovery, Ebola might be found in some body fluids, including
semen. The time it takes for Ebola to leave the semen is different for
each man. For some men who survived Ebola, the virus left their semen in
three months. For other men, the virus did not leave their semen for
more than nine months. Based on the results from limited studies
conducted to date, it appears that the amount of virus decreases over
time and eventually leaves the semen.

There are however, experimental treatments that have come about as a
result of the outbreak in Africa in 2014. The experimental treatment
called ZMapp and has been created with collaboration between different
companies in the United States and Canada. The treatment is not a
vaccine but a treatment that uses three monoclonal antibodies that have
been prepared from the Nicotiana plant. This new experimental treatment
shows promise and was recently given a fast track approval by the United
States Food and Drug Administration in September 2015.

The newest line of defense in war against Ebola is an experimental
vaccine that is being tested by the Centers for Disease Control and the
Sierra Leone Ministry of Health. The vaccine name is the rVSV-ZEBOV. The
program developed is called the Sierra Leone Trial to Introduce a
Vaccine against Ebola (STRIVE). The STRIVE program has enrolled roughly
6,000 volunteers to test the vaccine; most of the volunteers are health
care workers and those working on the forefront of the disease
treatment. The vaccine works by making a vesicular stomatitis virus
carry a non-infective Ebola virus gene. This part of the Ebola virus
cannot be disease causing but will trigger an immune response for
protection against the disease. This vaccine is still in the early
stages but may yield promise in the prevention of this most horrible
disease.

A Few Words About the Zika Virus

So what lies ahead of the United States health system, nothing may pose
a bigger threat in our day than the Zika virus; not for its’ severity
illness or lethality, but for the long-term effect that it threatens our
youth.

Although recently in the news, the Zika virus was first discovered in
1947 and named after the Zika Forest in UgandaIn the reporting cases of
this viral disease, there have been cases of infection in Africa, Asia
and Islands in the Pacific.

The Zika virus is spread primarily through the bite of the infected
mosquito species called Aedes. The virus can also be spread by
unprotected sex from an infected male. The disease is marked by
uncharacteristic signs and symptoms of fever, rash, arthralgia,
malaise and conjunctival symptoms. The disease progresses usually no
later than one week and is usually not severe enough to require
hospitalization with that person protected from future infections after
being initially infected. The main concern for the Zika virus is the
transmission of the virus from the expectant mothers to their unborn
children with the resultant birth defects that occur as a result. The
main birth defect is that of microcephaly with other defects such as eye
defects, loss of hearing and growth retardation.

The main treatment for the Zika virus disease is that of supportive care
such as fluids to prevent dehydration, pain meds such as Tylenol and
rest. The main prevention strategies for Zika are to prevent the
environment for mosquitos to flourish such as taking care of open
garbage containers, preventing standing water in outdoor areas and
covering water containers. Other measures for prevention include wearing
long sleeve shirts in the summer, using insect repellant and utilizing
condom use when engaging in sexual relations with someone who is known
to be recently from a Zika infected area. As of this date there is no
vaccine known for the Zika Virus.

Wrapping It Up

In the face of many obstacles that our healthcare system is
transitioning, we as nurses dare not give way to either fear and or
ignorance of the new threats facing us in the wake of the latest Ebola
and Zika emergencies. Only with determination and knowledge can we move
forward and not only survive but thrive in this environment.

No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any mechanical or electronic means, photocopying, recording or otherwise, without prior written permission of copyright holder. "Convenience and a Choice..." is a service mark (SM) of the National Center of Continuing Education, Inc.